Medicines Care Quotes

The art of medicine consists of amusing the patient while nature cures the disease.

It’s true that AI can mimic the human brain, but it can also outperform us mere humans by discovering complex patterns that no human being could ever process and identify.

The books we read should be chosen with great care, that they may be, as an Egyptian king wrote over his library,'The medicines of the soul.

In my opinion, our health care system has failed when a doctor fails to treat an illness that is treatable.

It is very expensive to give bad medical care to poor people in a rich country.

Let us be the ones who say we do not accept that a child dies every three seconds simply because he does not have the drugs you and I have. Let us be the ones to say we are not satisfied that your place of birth determines your right for life. Let us be outraged, let us be loud, let us be bold.

Pilots used to fly planes manually, but now they operate a dashboard with the help of computers. This has made flying safer and improved the industry. Healthcare can benefit from the same type of approach, with physicians practicing medicine with the help of data, dashboards, and AI. This will improve the quality of care they provide and make their jobs easier and more efficient

Yes. What is it, guilt, revenge, love, what?” I swallowed. “I live alone.” "And your point is?” "You have the Pack. You’re surrounded by people who would fall over themselves for the pleasure of your company. I have no one. My parents are dead, my entire family is gone. I have no friends. Except Jim, and that’s more of a working relationship than anything else. I have no lover. I can’t even have a pet, because I’m not at the house often enough to keep it from starving. When I come crawling home, bleeding and filthy and exhausted, the house is dark and empty. Nobody keeps the porch light on for me. Nobody hugs me and says, ‘Hey, I’m glad you made it. I’m glad you’re okay. I was worried.’ Nobody cares if I live or die. Nobody makes me coffee, nobody holds me before I go to bed, nobody fixes my medicine when I’m sick. I’m by myself.

Anywhere you have extreme poverty and no national health insurance, no promise of health care regardless of social standing, that's where you see the sharp limitations of market-based health care.

One smile has the power to... Calm fears. Soften stone walls. Warm a cold heart. Invite a new friend. Mimic a loving hug. Beautify the bearer. Lighten heavy loads. Promote good deeds. Brighten a gloomy day. Comfort a grieving spirit. Offer hope to the forlorn. Send a message of caring. Lift the downtrodden soul. Patch up invisible wounds. Weaken the hold of misery. Act as medicine for suffering. Attract the companionship of angels. Fulfill the human need for recognition. Who knew changing the world would prove so simple?

When someone hurts you time and time again, accept the fact that they don't care about you. Its a tough pill to swallow, but its necessary medicine.

The doctor of the future will give no medicine, but will interest his (sic)patient in the care of the human frame, in diet and in the cause and prevention of disease

I've been asked a lot for my view on American health care. Well, 'it would be a good idea,' to quote Gandhi.

Give people what they need: food, medicine, clean air, pure water, trees and grass, pleasant homes to live in, some hours of work, more hours of leisure. Don't ask who deserves it. Every human being deserves it.

You're going to make it; You're going to be at peace; You're going to create, and love, and laugh, and live; You're going to do great things.

This is how most stories end in the hospital. Not with crash carts and sirens and electric shocks to the chest, but with an empty room, a crisp white bed, silence.

A student once asked anthropologist Margaret Mead, “What is the earliest sign of civilization?” The student expected her to say a clay pot, a grinding stone, or maybe a weapon. Margaret Mead thought for a moment, then she said, “A healed femur.” A femur is the longest bone in the body, linking hip to knee. In societies without the benefits of modern medicine, it takes about six weeks of rest for a fractured femur to heal. A healed femur shows that someone cared for the injured person, did their hunting and gathering, stayed with them, and offered physical protection and human companionship until the injury could mend. Mead explained that where the law of the jungle—the survival of the fittest—rules, no healed femurs are found. The first sign of civilization is compassion, seen in a healed femur.

The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days.

The beauty of life isn't the perfectioned moments or storybook endings; the beauty of life is when you fall flat on your face, the Lord picks you up, then you look around and cheer, after all, a merry heart is the medicine!

Gomers are human beings who have lost what goes into being human beings. They want to die, and we will not let them.

Some people when they see cheese, chocolate or cake they don't think of calories.

I've been accustomed to mysteries, holy and otherwise, since I was a child. Some of us care for orphans, amass fortunes, raise protests or Nielsen ratings; some of us take communion or whiskey or poison. Some of us take lithium and antidepressants, and most everyone believes these pills are fundamentally wrong, a crutch, a sign of moral weakness, the surrender of art and individuality. Bullshit. Such thinking guarantees tradgedy for the bipolar. Without medicine, 20 percent of us, one in five, will commit suicide. Six-gun Russian roulette gives better odds. Denouncing these medicines makes as much sense as denouncing the immorality of motor oil. Without them, sooner or later the bipolar brain will go bang. I know plenty of potheads who sermonize against the pharmaceutical companies; I know plenty of born-again yoga instructors, plenty of missionaries who tell me I'm wrong about lithium. They don't have a clue.

What we are fighting isn't godlessness--this is the most godly country on earth. We aren't even fighting disease. Its poverty. Money for food, medicines... that helps. When we cannot cure or save a life, our patients can at least feel cared for. It should be a basic human right.

For where else can I go to sample daily the richness of life in all its profound chaos?

Rice is to nourish,” A-ma says. “Tea is to heal. Always remember that food is medicine, and medicine is food. If you take care of the trees, the trees will take care of you.

Back in 1903, Thomas Edison predicted that the “doctor of the future will give no medicine, but will instruct his patient in the care of [the] human frame in diet and in the cause and prevention of diseases.

In the latter months of his own long sickness the Master Herbal had taught him much of the healer's lore, and the first lesson and the last of all that lore was this: Heal the wound and cure the illness, but let the dying spirit go.

The gut is the seat of all feeling. Polluting the gut not only cripples your immune system, but also destroys your sense of empathy, the ability to identify with other humans.

One of the first things we teach medical students is to listen to the patient by taking a careful medical history. Ninety percent of the time, you can arrive at an uncannily accurate diagnosis by paying close attention, using physical examination and sophisticated lab test to confirm your hunch (and to increase the bill to the insurance company).

Food, Ivan Arnoldovich, is a subtle thing. One must know how to eat, yet just think – most people don’t know how to eat at all. One must not only know what to eat, but when and how.’ (Philip Philipovich waved his fork meaningfully.) ‘And what to say while you’re eating. Yes, my dear sir. If you care about your digestion, my advice is – don’t talk about bolshevism or medicine at table. And, God forbid – never read Soviet newspapers before dinner.’ ‘M’mm . . . But there are no other newspapers.’ ‘In that case don’t read any at all. Do you know I once made thirty tests in my clinic. And what do you think? The patients who never read newspapers felt excellent. Those whom I specially made read Pravda all lost weight.

The gut is the seat of all feeling. Polluting the gut not only cripples your immune system, but also destroys your sense of empathy, the ability to identify with other humans. Bad bacteria in the gut creates neurological issues. Autism can be cured by detoxifying the bellies of young children. People who think that feelings come from the heart are wrong. The gut is where you feel the loss of a loved one first. It's where you feel pain and a heavy bulk of your emotions. It's the central base of your entire immune system. If your gut is loaded with negative bacteria, it affects your mind. Your heart is the seat of your conscience. If your mind is corrupted, it affects your conscience. The heart is the Sun. The gut is the Moon. The pineal gland is Neptune, and your brain and nervous system (5 senses) are Mercury. What affects the moon or sun affects the entire universe within. So, if you poison the gut, it affects your entire nervous system, your sense of reasoning, and your senses.

A woman's body is a sacred temple. A work of art, and a life-giving vessel. And once she becomes a mother, her body serves as a medicine cabinet for her infant. From her milk she can nourish and heal her own child from a variety of ailments. And though women come in a wide assortment as vast as the many different types of flowers and birds, she is to reflect divinity in her essence, care and wisdom. God created a woman's heart to be a river of love, not to become a killing machine.

Happiness isn't something to carefully measure out in spoonfuls as though it's medicine. I don't need you to suffer to prove your love, and I definitely don't need you to hide your suffering. I want to shoulder half our burden.

I believe the vital ingredient is love—a state of caring and compassion that is so deep and genuine that the barriers we erect around the self are transcended.

Cannabis is just way too healthy for a sick health care system

It is worth saying something about the social position of beggars, for when one has consorted with them, and found that they are ordinary human beings, one cannot help being struck by the curious attitude that society takes towards them. People seem to feel that there is some essential difference between beggars and ordinary 'working' men. They are a race apart--outcasts, like criminals and prostitutes. Working men 'work', beggars do not 'work'; they are parasites, worthless in their very nature. It is taken for granted that a beggar does not 'earn' his living, as a bricklayer or a literary critic 'earns' his. He is a mere social excrescence, tolerated because we live in a humane age, but essentially despicable. Yet if one looks closely one sees that there is no ESSENTIAL difference between a beggar's livelihood and that of numberless respectable people. Beggars do not work, it is said; but, then, what is WORK? A navvy works by swinging a pick. An accountant works by adding up figures. A beggar works by standing out of doors in all weathers and getting varicose veins, chronic bronchitis, etc. It is a trade like any other; quite useless, of course--but, then, many reputable trades are quite useless. And as a social type a beggar compares well with scores of others. He is honest compared with the sellers of most patent medicines, high-minded compared with a Sunday newspaper proprietor, amiable compared with a hire-purchase tout--in short, a parasite, but a fairly harmless parasite. He seldom extracts more than a bare living from the community, and, what should justify him according to our ethical ideas, he pays for it over and over in suffering. I do not think there is anything about a beggar that sets him in a different class from other people, or gives most modern men the right to despise him. Then the question arises, Why are beggars despised?--for they are despised, universally. I believe it is for the simple reason that they fail to earn a decent living. In practice nobody cares whether work is useful or useless, productive or parasitic; the sole thing demanded is that it shall be profitable. In all the modem talk about energy, efficiency, social service and the rest of it, what meaning is there except 'Get money, get it legally, and get a lot of it'? Money has become the grand test of virtue. By this test beggars fail, and for this they are despised. If one could earn even ten pounds a week at begging, it would become a respectable profession immediately. A beggar, looked at realistically, is simply a businessman, getting his living, like other businessmen, in the way that comes to hand. He has not, more than most modem people, sold his honour; he has merely made the mistake of choosing a trade at which it is impossible to grow rich.

The core predicament of medicine - the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of society that pays the bills they run up so vexing - is uncertainty. With all that we know nowadays about people and diseases and how to diagnose and treat them, it can be hard to see this, hard to grasp how deeply uncertainty runs. As a doctor, you come to find, however, that the struggle in caring for people is more often with what you do not know than what you do. Medicine's ground state is uncertainty. And wisdom - for both the patients and doctors - is defined by how one copes with it.

This was my wake-up call. I opened my eyes to the depressing fact that there are other forces at work in medicine besides science. The U.S. health care system runs on a fee-for-service model in which doctors get paid for the pills and procedures they prescribe, rewarding quantity over quality. We don’t get reimbursed for time spent counseling our patients about the benefits of healthy eating. If doctors were instead paid for performance, there would be a financial incentive to treat the lifestyle causes of disease. Until the model of reimbursement changes, I don’t expect great changes in medical care or medical education.5

I'm taking inorganic chem and physics not because I want to but because I have to. Not every doctor wants to be a scientist. Some of us just want to take care of sick people. I can't help thinking that medicine is more closely aligned to the humanities than to the sciences. I can't help thinking that I could learn more about being a good doctor from William Shakespeare than I could from Isaac Newton. After all, isn't understanding people at least as important as understanding pathology?

Walt Whitman (1819–1892). Leaves of Grass. 1900. To You WHOEVER you are, I fear you are walking the walks of dreams, I fear these supposed realities are to melt from under your feet and hands; Even now, your features, joys, speech, house, trade, manners, troubles, follies, costume, crimes, dissipate away from you, Your true Soul and Body appear before me, They stand forth out of affairs—out of commerce, shops, law, science, work, forms, clothes, the house, medicine, print, buying, selling, eating, drinking, suffering, dying. Whoever you are, now I place my hand upon you, that you be my poem; I whisper with my lips close to your ear, I have loved many women and men, but I love none better than you. O I have been dilatory and dumb; I should have made my way straight to you long ago; I should have blabb’d nothing but you, I should have chanted nothing but you. I will leave all, and come and make the hymns of you; None have understood you, but I understand you; None have done justice to you—you have not done justice to yourself; None but have found you imperfect—I only find no imperfection in you; None but would subordinate you—I only am he who will never consent to subordinate you; I only am he who places over you no master, owner, better, God, beyond what waits intrinsically in yourself. Painters have painted their swarming groups, and the centre figure of all; From the head of the centre figure spreading a nimbus of gold-color’d light; But I paint myriads of heads, but paint no head without its nimbus of gold-color’d light; From my hand, from the brain of every man and woman it streams, effulgently flowing forever. O I could sing such grandeurs and glories about you! You have not known what you are—you have slumber’d upon yourself all your life; Your eye-lids have been the same as closed most of the time; What you have done returns already in mockeries; (Your thrift, knowledge, prayers, if they do not return in mockeries, what is their return?) The mockeries are not you; Underneath them, and within them, I see you lurk; I pursue you where none else has pursued you; Silence, the desk, the flippant expression, the night, the accustom’d routine, if these conceal you from others, or from yourself, they do not conceal you from me; The shaved face, the unsteady eye, the impure complexion, if these balk others, they do not balk me, The pert apparel, the deform’d attitude, drunkenness, greed, premature death, all these I part aside. There is no endowment in man or woman that is not tallied in you; There is no virtue, no beauty, in man or woman, but as good is in you; No pluck, no endurance in others, but as good is in you; No pleasure waiting for others, but an equal pleasure waits for you. As for me, I give nothing to any one, except I give the like carefully to you; I sing the songs of the glory of none, not God, sooner than I sing the songs of the glory of you. Whoever you are! claim your own at any hazard! These shows of the east and west are tame, compared to you; These immense meadows—these interminable rivers—you are immense and interminable as they; These furies, elements, storms, motions of Nature, throes of apparent dissolution—you are he or she who is master or mistress over them, Master or mistress in your own right over Nature, elements, pain, passion, dissolution. The hopples fall from your ankles—you find an unfailing sufficiency; Old or young, male or female, rude, low, rejected by the rest, whatever you are promulges itself; Through birth, life, death, burial, the means are provided, nothing is scanted; Through angers, losses, ambition, ignorance, ennui, what you are picks its way.

The night before brain surgery, I thought about death. I searched out my larger values, and I asked myself, if I was going to die, did I want to do it fighting and clawing or in peaceful surrender? What sort of character did I hope to show? Was I content with myself and what I had done with my life so far? I decided that I was essentially a good person, although I could have been better--but at the same time I understood that the cancer didn't care. I asked myself what I believed. I had never prayed a lot. I hoped hard, I wished hard, but I didn't pray. I had developed a certain distrust of organized religion growing up, but I felt I had the capacity to be a spiritual person, and to hold some fervent beliefs. Quite simply, I believed I had a responsibility to be a good person, and that meant fair, honest, hardworking, and honorable. If I did that, if I was good to my family, true to my friends, if I gave back to my community or to some cause, if I wasn't a liar, a cheat, or a thief, then I believed that should be enough. At the end of the day, if there was indeed some Body or presence standing there to judge me, I hoped I would be judged on whether I had lived a true life, not on whether I believed in a certain book, or whether I'd been baptized. If there was indeed a God at the end of my days, I hoped he didn't say, 'But you were never a Christian, so you're going the other way from heaven.' If so, I was going to reply, 'You know what? You're right. Fine.' I believed, too, in the doctors and the medicine and the surgeries--I believed in that. I believed in them. A person like Dr. Einhorn [his oncologist], that's someone to believe in, I thought, a person with the mind to develop an experimental treatment 20 years ago that now could save my life. I believed in the hard currency of his intelligence and his research. Beyond that, I had no idea where to draw the line between spiritual belief and science. But I knew this much: I believed in belief, for its own shining sake. To believe in the face of utter hopelessness, every article of evidence to the contrary, to ignore apparent catastrophe--what other choice was there? We do it every day, I realized. We are so much stronger than we imagine, and belief is one of the most valiant and long-lived human characteristics. To believe, when all along we humans know that nothing can cure the briefness of this life, that there is no remedy for our basic mortality, that is a form of bravery. To continue believing in yourself, believing in the doctors, believing in the treatment, believing in whatever I chose to believe in, that was the most important thing, I decided. It had to be. Without belief, we would be left with nothing but an overwhelming doom, every single day. And it will beat you. I didn't fully see, until the cancer, how we fight every day against the creeping negatives of the world, how we struggle daily against the slow lapping of cynicism. Dispiritedness and disappointment, these were the real perils of life, not some sudden illness or cataclysmic millennium doomsday. I knew now why people fear cancer: because it is a slow and inevitable death, it is the very definition of cynicism and loss of spirit. So, I believed.

We grow up and figure out the truth, we realize how hard it is to maintain and take care of life, even the ones that deceive you, especially the ones you cherish

Modern allopathic medicine is the only major science stuck in the pre-Einstein era.

Love in your heart is good medicine for long live. Hatred in your blood is the major cause of heart failure! Love people, get transfused with a fresh blood and you'll live long!

elderly are left with a controlled and supervised institutional existence, a medically designed answer to unfixable problems, a life designed to be safe but empty of anything they care about.

Seeing modern health care from the other side, I can say that it is clearly not set up for the patient. It is frequently a poor arrangement for doctors as well, but that does not mitigate how little the system accounts for the patient's best interest. Just when you are at your weakest and least able to make all the phone calls, traverse the maze of insurance, and plead for health-care referrals is that one time when you have to — your life may depend on it.

Certainly the primary imperative of a physician is to be skilled in medical science, but if he or she does not probe a patient's soul, then the doctor's care is given without caring, and part of the sacred mission of healing is missing.

There is lovemaking that is bad for a person, just as there is eating that is bad. That boysenberry cream pie from the Thrift-E Mart may appear inviting, may, in fact, cause all nine hundred taste buds to carol from the tongue, but in the end, the sugars, the additives, the empty calories clog arteries, disrupt cells, generate fat, and rot teeth. Even potentially nourishing foods can be improperly prepared. There are wrong combinations and improper preparations in sex as well. Yes, one must prepare for a fuck--the way an enlightened priest prepares to celebrate mass, the way a great matador prepares for the ring: with intensification, with purification, with a conscious summoning of sacred power. And even that won't work if the ingredients are poorly matched: oysters are delectable, so are strawberries, but mashed together ... (?!) Every nutritious sexual recipe calls for at least a pinch of love, and the fucks that rate four-star rankings from both gourmets and health-food nuts use cupfuls. Not that sex should be regarded as therapeutic or to be taken for medicinal purposes--only a dullard would hang such a millstone around the nibbled neck of a lay--but to approach sex carelessly, shallowly, with detachment and without warmth is to dine night after night in erotic greasy spoons. In time, one's palate will become insensitive, one will suffer (without knowing it) emotional malnutrition, the skin of the soul will fester with scurvy, the teeth of the heart will decay. Neither duration nor proclamation of commitment is necessarily the measure--there are ephemeral explosions of passion between strangers that make more erotic sense than lengthy marriages, there are one-night stands in Jersey City more glorious than six-months affairs in Paris--but finally there is a commitment, however brief; a purity, however threatened; a vulnerability, however concealed; a generosity of spirit, however marbled with need; and honest caring, however singled by lust, that must be present if couplings are to be salubrious and not slow poison.

The next morning, when I went in to the bathroom to brush my teeth, I noticed the index card over the sink. RIGHT FAUCET DRIPS EASILY, it said. TIGHTEN WITH WRENCH AFTER USING. And then there was an arrow, pointing down to where a small wrench was tied with bright red yarn to one of the pipes. This is crazy, I thought. But that wasn't all. In the shower, HOT WATER IS VERY HOT! USE WITH CARE was posted over the soap dish. And on the toilet: HANDLE LOOSE. DON'T YANK. (As if I had some desire to do that.) The overhead fan was clearly BROKEN, the tiles by the door were LOOSE so I had to WALK CAREFULLY. And I was informed, cryptically, that the light over the medicine cabinet works, BUT ONLY SOMETIMES.

no disease suffered by a live man can be known, for every living person has his own peculiarities and always has his own peculiar, personal, novel, complicated disease, unknown to medicine -- not a disease of the lungs, liver, skin, heart, nerves, and so on mentioned in medical books, but a disease consisting of one of the innumerable combinations of the maladies of those organs. This simple thought could not occur to the doctors (as it cannot occur to a wizard that he is unable to work his charms) because the business of their lives was to cure, and they received money for it and had spent the best years of their lives on that business. But above all that thought was kept out of their minds by the fact that they saw they were really useful [...] Their usefulness did not depend on making the patient swallow substances for the most part harmful (the harm was scarcely perceptible because they were given in small doses) but they were useful, necessary, and indispensable because they satisfied a mental need of the invalid and those who loved her -- and that is why there are, and always will be, pseudo-healers, wise women, homoeopaths, and allopaths. They satisfied that eternal human need for hope of relief, for sympathy, and that something should be done, which is felt by those who are suffering.

It was all here for me, just as it has all been here for you, the best and the worst of Western Civilization, if you cared to pay attention: music, finance, government, architecture, law and sculpture and painting, history and medicine and athletics and every sort of science, and books, books, books, and teachers and role models. People so smart you can’t believe it, and people so dumb you can’t believe it. People so nice you can’t believe it, and people so mean you can’t believe it.

A landmark 2010 study from the Massachusetts General Hospital had even more startling findings. The researchers randomly assigned 151 patients with stage IV lung cancer, like Sara’s, to one of two possible approaches to treatment. Half received usual oncology care. The other half received usual oncology care plus parallel visits with a palliative care specialist. These are specialists in preventing and relieving the suffering of patients, and to see one, no determination of whether they are dying or not is required. If a person has serious, complex illness, palliative specialists are happy to help. The ones in the study discussed with the patients their goals and priorities for if and when their condition worsened. The result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.

A fine single malt whisky, of course, is purely medicinal - it cures all manner of ailments one may care to imagine.

The whole world is medicine'. We can learn from everything that happens to us.

In psychology it is very important that the doctor should not strive to heal at all costs. One has to be exceedingly careful not to impose one's own will and conviction on the patient. You have to give him a certain amount of freedom. You can't wrest people away from their fate, just as in medicine you cannot cure a patient if nature means him to die. Sometimes it is really a question whether you are allowed to rescue a man from the fate he must undergo for the sake of his further development.

Healing is a biological process, not an art. It is as much a function of the living organism as respiration, digestion, circulation, excretion, cell proliferation, or nerve activity. It is a ceaseless process, as constant as the turning of the earth on its axis. Man can neither duplicate nor imitate nor provide a substitute for the process. All schools of healing are frauds.

Miss N. had taught her nurses to watch carefully in order to understand what the ill required and provide it. Not medicine—that was the doctors’ domain—but the things she argued were equally crucial to recovery: light, air, warmth, cleanliness, rest, comfort, nourishment, and conversation.

Me and the folks who buy my food are like the Indians -- we just want to opt out. That's all the Indians ever wanted -- to keep their tepees, to give their kids herbs instead of patent medicines and leeches. They didn't care if there was a Washington, D.C., or a Custer or a USDA; just leave us alone. But the Western mind can't bear an opt-out option. We're going to have to refight the Battle of the Little Big Horn to preserve the right to opt out, or your grandchildren and mine will have no choice but to eat amalgamated, irradiated, genetically prostituted, barcoded, adulterated fecal spam from the centralized processing conglomerate.

You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. These days are spent in institutions—nursing homes and intensive-care units—where regimented, anonymous routines cut us off from all the things that matter to us in life.

We may indeed be justly proud of our apostolic succesion. THESE ARE OUR METHODS - to carefully observe the phenomena of life in all its stages , to cultivate reasoning faculty so as to be able to know the true from the false. THIS IS OUR WORK - to prevent disease, to relieve suffering and to heal the sick.

Once a patient goes brain dead and relatives sign his organ donation consent form, he will get the best medical treatment of his life. A hospital code blue may be a call for doctors to rush to the bedside of a beating heart cadaver who needs his or her heart defibrillated.

I was not prepared to think of the people I had lost, or to speak of them, although we did, carefully, without letting their names loose in the wind that would reach their ears. We feared that they would hear us and never rest, come back out of pity for the loneliness we felt.

Cry Out in Your Weakness A dragon was pulling a bear into its terrible mouth. A courageous man went and rescued the bear. There are such helpers in the world, who rush to save anyone who cries out. Like Mercy itself, they run toward the screaming. And they can’t be bought off. If you were to ask one of those, “Why did you come so quickly?” He or she would say, “Because I heard your helplessness.” Where lowland is, that’s where water goes. All medicine wants is pain to cure. And don’t just ask for one mercy. Let them flood in. Let the sky open under your feet. Take the cotton out of your ears, the cotton of consolations, so you can hear the sphere-music. . . . Give your weakness to One Who Helps. Crying out loud and weeping are great resources. A nursing mother, all she does is wait to hear her child. Just a little beginning-whimper, and she’s there. God created the child, that is, your wanting, so that it might cry out, so that milk might come. Cry out! Don’t be stolid and silent with your pain. Lament! And let the milk of Loving flow into you. The hard rain and wind are ways the cloud has to take care of us. Be patient. Respond to every call that excites your spirit. Ignore those that make you fearful and sad, that degrade you back toward disease and death.

Mrs. Cadwallader said, privately, 'You will certainly go mad in that house alone, my dear. You will see visions. We have all got to exert ourselves a little to keep sane, and call things by the same names as other people call them by. To be sure, for younger sons and women who have no money, it is a sort of provision to go mad: they are taken care of then. But you must not run into that. I daresay you are a little bored here with our good dowager; but think what a bore you might become yourself to your fellow-creatures if you were always playing tragedy queen and taking things sublimely. Sitting alone in that library at Lowick you may fancy yourself ruling the weather; you must get a few people round you who wouldn't believe you if you told them. That is a good lowering medicine.

magine a trust in yourself, or another person, or in life itself, that doesn’t need to be proved or demonstrated, that is able to contain uncertainty. People sometimes put their trust in a spiritual leader and are terribly betrayed if that person then fails to live up to ideals. But a real trust of faith would be to decide whether to trust someone, knowing that betrayal is inevitable because life and personality are never without shadow. The vulnerability that faith demands could be matched by an equal trust in oneself, the feeling that one can survive the pain of betrayal.

Doctors tend to enter the arenas of their profession's practice with a brisk good cheer that they have to then stop and try to mute a bit when the arena they're entering is a hospital's fifth floor, a psych ward, where brisk good cheer would amount to a kind of gloating. This is why doctors on psych wards so often wear a vaguely fake frown of puzzled concentration, if and when you see them in fifth-floor halls. And this is why a hospital M.D.--who's usually hale and pink-cheeked and poreless, and who almost always smells unusually clean and good--approaches any psych patient under this care with a professional manner somewhere between bland and deep, a distant but sincere concern that's divided evenly between the patient's subjective discomfort and the hard facts of the case.

Speechlessness, however, affirmed in the diagnosis, is carefully based on the facts of the examination, as we see by rendering the statements concerned, just as they stand in examination and diagnosis: "If thou examinest a man having a wound in the temple, ...; if thou ask of him concerning his malady and he speak not to thee; ...; thou shouldst say concerning him, 'One having a wound in his temple, ... (and) he is speechless'.

Go ahead! Keep breaking them!” he yelled. “There's plenty of medicine where that came from. Break one bowl and I'll bring twenty more! I'll keep forcing it down your throat until you drink it all!” “Aaaaaah! Can't you just leave me alone?! Just let me die!” Shi Qingxcuan screamed. “I'm your brother!” Shi Wudu snapped. “If I don't take care of you, who will?!

Every nutritious sexual recipe calls for at least a pinch of love, and the fucks that rate four-star rankings from both gourmets and health-food nuts used cupfuls. Not that sex should be regarded as therapeutic or to be taken for medicinal purposes - only a dullard would hang such a millstone around the nibbled neck of a lay - but to approach sex carelessly, shallowly, with detachment and without warmth is to dine night after night in erotic greasy spoons. In time, one's palate will become insensitive, one will suffer (without knowing it) emotional malnutrition, the skin of the soul will fester with scurvy, the teeth of the heart will decay. Neither duration nor proclamation of commitment is necessarily the measure - there are ephemeral explosions of passion between strangers that make more erotic sense than many lengthy marriages, there are one-night stands in Jersey City more glorious than six-months affairs in Paris - but finally there is a commitment, however brief; a purity, however threatened; a vulnerability, however concealed; a generosity of spirit, however marbled with need; an honest caring, however singed by lust, that must be present if couplings are to be salubrious and not slow poison.

Does that mean that religious texts are worthless as guides to ethics? Of course not. They are magnificent sources of insight into human nature, and into the possibilities of ethical codes. Just as we should not be surprised to discover that ancient folk medicine has a great deal to teach modern hightech medicine, we should not be surprised if we find that these great religious texts hold versions of the very best ethical systems any human culture will ever devise. But, like folk medicine, we should test it all carefully, and take nothing whatever on faith.

The result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. If end-of-life discussions were an experimental drug, the FDA would approve it.

In a devastating of example critical thinking gone bad, highly educated, deeply caring parents avoid the vaccinations that would protect their children from killer diseases. I love critical thinking and I admire scepticism, but only in a framework that respects evidence. So if you are sceptical about the measles vaccinations, I ask you to do two things. First, make sure you know what it looks like when a child dies of measles. Most children who catch measles recover, but there is still no cure and even with the best modern medicine, one or two in every thousand will die from it. Second, ask yourself, “What kind of evidence would convince me change my mind about vaccination. If the answer is ‘no evidence could ever change my mind about vaccination,” then you are putting yourself outside evidence-based rationality, outside the very critical thinking that first brought you to this point. In that case, to be consistent in your scepticism about science, next time you have an operation please ask your surgeon not to bother washing her hands.

Consider the case of La Crosse, Wisconsin. Its elderly residents have unusually low end-of-life hospital costs. During their last six months, according to Medicare data, they spend half as many days in the hospital as the national average, and there’s no sign that doctors or patients are halting care prematurely. Despite average rates of obesity and smoking, their life expectancy outpaces the national mean by a year.

A MANTRA FOR HOME HEALTH CARE I am my own healer. I have a radiant voice within that guides me. I can make decisions for myself. I can rely on others as needed, but at my discretion. It is my body, my health, my balance, and my responsibility to make right choices for myself. Right choices include working with competent health-care professionals when necessary, allowing friends and family to help as needed, and, above all, being true to my beliefs, with the wisdom and willingness to change as part of the path of healing.

As different as Emily Dickinson’s parents’ life in America seems from that of Sitaram Gawande’s in India, both relied on systems that shared the advantage of easily resolving the question of care for the elderly. There was no need to save up for a spot in a nursing home or arrange for meals-on-wheels. It was understood that parents would just keep living in their home, assisted by one or more of the children they’d raised. In contemporary societies, by contrast, old age and infirmity have gone from being a shared, multigenerational responsibility to a more or less private state—something experienced largely alone or with the aid of doctors and institutions. How did this happen? How did we go from Sitaram Gawande’s life to Alice Hobson’s?

If to be human is to be limited, then the role of caring professions and institutions - from surgeons to nursing homes - ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the large aims of a person's life. When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking.

Why say 'the world is complicated' and stop there? I say the world is complicated but not incomprehensible. Only you have to look at it steadily. Isn't it true a person's shoulder hurts sometimes because they've got a disorder in their stomach? And then what does a stupid doctor do? Order massages for the shoulder. What does a wise doctor do? He takes time to think about it, watches the patient carefully, gives him some medicine for his stomach, and the pain in his shoulder goes away. Better yet, he explains to his patients what they have to do to keep their stomach from getting out of order. One day his patient's going to get old and die, just like himself, just like us, and one day, incredible as it may seem, the Empire's going to die, and how foolish people are who whine about it, and whine about how complicated the world is. A seamstress's room is complicated too, but even at night, with the lights out, she can reach out in the darkness and find the yellow thread, the needles, the pincushion. We couldn't, because we don't know the order things are in, in the seamstress's room. And we can't see the order the world is in. But all the same it's there, right under our eyes.

[I]t seems to me that a lot of the stranger ideas people have about medicine derive from an emotional struggle with the very notion of a pharmaceutical industry. Whatever our political leanings, we all feel nervous about profit taking any role in the caring professions, but that feeling has nowhere to go. Big pharma is evil; I would agree with that premise. But because people don’t understand exactly how big pharma is evil, their anger gets diverted away from valid criticisms—its role in distorting data, for example, or withholding lifesaving AIDS drugs from the developing world—and channeled into infantile fantasies. “Big pharma is evil,” goes the line of reasoning; “therefore homeopathy works and the MMR vaccine causes autism.” This is probably not helpful.

Our world is falling apart quietly. Human civilization has reduced the plant, a four-million-year-old life form, into three things: food, medicine, and wood. In our relentless and ever-intensifying obsession with obtaining a higher volume, potency, and variety of these three things, we have devastated plant ecology to an extent that millions of years of natural disaster could not. Roads have grow like a manic fungus and the endless miles of ditches that bracket these roads serve as hasty graves for perhaps millions of plant species extinguished in the name of progress. Planet Earth is nearly a Dr. Seuss book made real: every year since 1990 we have created more than eight billion new stumps. If we continue to fell healthy trees at this rate, less then six hundred years from now, every tree on the planet will have been reduced to a stump. My job is about making sure there will be some evidence that someone cared about the great tragedy that unfolded during our age.

How much does it cost to treat leprosy? One $3 dose of antibiotic will cure a mild case; a $20 regimen of three antibiotics will cure a more severe case. The World Health Organization even provides the drugs free, but India‘s health care infrastructure is not good enough to identify the afflicted and get them the medicine they need. So, more than 100,000 people in India are horribly disfigured by a disease that costs $3 to cure. That is what it means to have a per capita GDP of $2,900.

Imagine waking up in the morning and going to the kitchen and to make yourself some breakfast. You take some soybean grits, mix them with some tainted cattle meat, throw in a few beaks and feathers, smother your concoction with processed sugar syrup and chemicals, then sprinkle on a few preservatives and dyes. Pressure cook the hell out of it, let it cool-and dig in!

Where there were once several competing approaches to medicine, there is now only one that matters to most hospitals, insurers, and the vast majority of the public. One that has been shaped to a great degree by the successful development of potent cures that followed the discovery of sulfa drugs. Aspiring caregivers today are chosen as much (or more) for their scientific abilities, their talent for mastering these manifold technological and pharmaceutical advances as for their interpersonal skills. A century ago most physicians were careful, conservative observers who provided comfort to patients and their families. Today they act: They prescribe, they treat, they cure. They routinely perform what were once considered miracles. The result, in the view of some, has been a shift in the profession from caregiver to technician. The powerful new drugs changed how care was given as well as who gave it.

Equally worrying, and far less recognized, medicine has been slow to confront the very changes that it has been responsible for—or to apply the knowledge we have about how to make old age better. Although the elderly population is growing rapidly, the number of certified geriatricians the medical profession has put in practice has actually fallen in the United States by 25 percent between 1996 and 2010. Applications to training programs in adult primary care medicine have plummeted, while fields like plastic surgery and radiology receive applications in record numbers. Partly, this has to do with money—incomes in geriatrics and adult primary care are among the lowest in medicine. And partly, whether we admit it or not, a lot of doctors don’t like taking care of the elderly.

In political economies, illness is seen as a drag on productivity. Frequent or prolonged illness is often seen as disqualifying or devaluing an individual’s labor power. There is a rush to be over with ill health and get back to work as quickly as possible. Rest is scarce, and all treatment under health capitalism is rationed along class lines. The ways we encounter medicine reflect this dynamic: care is designed around billable encounters, acute care is most easily accessible, and our cultural imaginary frames disease as some thing which is episodic.

If the woman were able to sit herself down and peer into her own heart, she would see there a need to have her talents, her gifts, and her limitations re­ spectfully acknowledged and accepted. So, to begin healing, stop kid­ ding yourself that a little feel-good of the wrong sort will take care of a broken leg. Tell the truth about your wound, and then you will get a truthful picture of the remedy to apply to it. Don’t pack whatever is easiest or most available into the emptiness. Hold out for the right medicine. You will recognize it because it makes your life stronger rather than weaker.

Where America really differs from other countries is in the colossal costs of its health care. An angiogram, a survey by The New York Times found, costs an average of $914 in the United States, $35 in Canada. Insulin costs about six times as much in America as it does in Europe. The average hip replacement costs $40,364 in America, almost six times the cost in Spain, while an MRI scan in the United States is, at $1,121, four times more than in the Netherlands. The entire system is notoriously unwieldy and cost-heavy. America has about 800,000 practicing physicians but needs twice that number of people to administer its payments system. The inescapable conclusion is that higher spending in America doesn’t necessarily result in better medicine, just higher costs.

Several years ago, researchers at the University of Minnesota identified 568 men and women over the age of seventy who were living independently but were at high risk of becoming disabled because of chronic health problems, recent illness, or cognitive changes. With their permission, the researchers randomly assigned half of them to see a team of geriatric nurses and doctors—a team dedicated to the art and science of managing old age. The others were asked to see their usual physician, who was notified of their high-risk status. Within eighteen months, 10 percent of the patients in both groups had died. But the patients who had seen a geriatrics team were a quarter less likely to become disabled and half as likely to develop depression. They were 40 percent less likely to require home health services. These were stunning results. If scientists came up with a device—call it an automatic defrailer—that wouldn’t extend your life but would slash the likelihood you’d end up in a nursing home or miserable with depression, we’d be clamoring for it. We wouldn’t care if doctors had to open up your chest and plug the thing into your heart. We’d have pink-ribbon campaigns to get one for every person over seventy-five. Congress would be holding hearings demanding to know why forty-year-olds couldn’t get them installed. Medical students would be jockeying to become defrailulation specialists, and Wall Street would be bidding up company stock prices. Instead, it was just geriatrics. The geriatric teams weren’t doing lung biopsies or back surgery or insertion of automatic defrailers. What they did was to simplify medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient’s home was safe. How do we reward this kind of work? Chad Boult, the geriatrician who was the lead investigator of the University of Minnesota study, can tell you. A few months after he published the results, demonstrating how much better people’s lives were with specialized geriatric care, the university closed the division of geriatrics.

New Rule: Not everything in America has to make a profit. If conservatives get to call universal health care "socialized medicine," I get to call private, for-profit health care "soulless vampire bastards making money off human pain." Now, I know what you're thinking: "But, Bill, the profit motive is what sustains capitalism." Yes, and our sex drive is what sustains the human species, but we don't try to fuck everything. It wasn't that long ago when a kid in America broke his leg, his parents took him to the local Catholic hospital, the nun stuck a thermometer in his ass, the doctor slapped some plaster on his ankle, and you were done. The bill was $1.50; plus, you got to keep the thermometer. But like everything else that's good and noble in life, some bean counter decided that hospitals could be big business, so now they're not hospitals anymore; they're Jiffy Lubes with bedpans. The more people who get sick, and stay sick, the higher their profit margins, which is why they're always pushing the Jell-O. Did you know that the United States is ranked fiftieth in the world in life expectancy? And the forty-nine loser countries were they live longer than us? Oh, it's hardly worth it, they may live longer, but they live shackled to the tyranny of nonprofit health care. Here in America, you're not coughing up blood, little Bobby, you're coughing up freedom. The problem with President Obama's health-care plan isn't socialism. It's capitalism. When did the profit motive become the only reason to do anything? When did that become the new patriotism? Ask not what you could do for your country, ask what's in it for Blue Cross Blue Shield. And it's not just medicine--prisons also used to be a nonprofit business, and for good reason--who the hell wants to own a prison? By definition, you're going to have trouble with the tenants. It's not a coincidence that we outsourced running prisons to private corporations and then the number of prisoners in America skyrocketed. There used to be some things we just didn't do for money. Did you know, for example, there was a time when being called a "war profiteer" was a bad thing? FDR said he didn't want World War II to create one millionaire, but I'm guessing Iraq has made more than a few executives at Halliburton into millionaires. Halliburton sold soldiers soda for $7.50 a can. They were honoring 9/11 by charging like 7-Eleven. Which is wrong. We're Americans; we don't fight wars for money. We fight them for oil. And my final example of the profit motive screwing something up that used to be good when it was nonprofit: TV news. I heard all the news anchors this week talk about how much better the news coverage was back in Cronkite's day. And I thought, "Gee, if only you were in a position to do something about it.

I feel him beside me, hear the even sound of his breathing, smell the delicious saltiness of his skin. I have missed him. I move to face him, and that’s when the pain reminds me that I’ve recently been stabbed. I bury my face in the pillow, but it doesn’t quite muffle my yelp. “Emma?” Galen says groggily. I feel his hand in my hair, stroking the length of it. “Don’t move, angelfish. Stay on your stomach. I’ll go tell Rachel you’re ready for more pain medicine.” Immediately I disobey and turn my face up to him. He shakes his head. “I’ve recently learned where your stubbornness comes from.” I grimace/smile. “My mom?” “Worse. King Antonis. The resemblance is uncanny.” He leans down and presses his lips to mine and all too quickly springs back up. “Now, be a good little deviant and stay put while I go get more pain meds.” “Galen,” I say. “Hmmm?” “How bad am I hurt?” He caresses the outline of my cheek. His touch could disintegrate me. “Hurt at all is bad enough for me.” “Yeah, but you’ve always been a baby about this stuff.” I grin at his faux offense. “Your mother says it’s only a flesh wound. She’s been treating it.” “Mom is here?” “She’s downstairs. Uh…You should know that Grom is here, too.” Grom left the tribunal and headed for land? Did that mean it all ended badly? Well, even worse than my getting impaled? An urgent need to know everything about everything shimmies through me. “Whoa. Sit. Talk. Now.” He laughs. “I will, I promise. But I want to make you comfortable first.” “Well, then, you need to come over here and switch places with the bed.” A blush fills my cheeks, but I don’t care. I need him. All of him. It feels like forever since we’ve talked like this, just me and him. But talking usually doesn’t last long. Lips were made for other things, too. And Galen is especially good at the other things. He walks back and squats by the bed. “You have no idea how tempting that is.” It seems like the violet of his eyes gets darker. It’s the color they get when he has to pull away from me, when we’re about to violate a bunch of Syrena laws if we don’t stop. “But you’re not well enough to…” He runs a hand through his hair. “I’ll go get Rachel. Then we can talk.” I’m a little surprised that his argument didn’t begin with “But the law…” That is what has stopped us in the past. Now the only thing that appears to be stopping us is my stabby condition. What’s changed? And why am I not excited about it? I used to get so frustrated when he would pull away. But a small part of me loved that about him, his respect for the law and for the tradition of his people. His respect for me. Respect is a hard thing to come by when picking from among human boys. Is that respect gone? And is it my fault?

IN 1908, A Harvard philosopher named Josiah Royce wrote a book with the title The Philosophy of Loyalty. Royce was not concerned with the trials of aging. But he was concerned with a puzzle that is fundamental to anyone contemplating his or her mortality. Royce wanted to understand why simply existing—why being merely housed and fed and safe and alive—seems empty and meaningless to us. What more is it that we need in order to feel that life is worthwhile? The answer, he believed, is that we all seek a cause beyond ourselves. This was, to him, an intrinsic human need. The cause could be large (family, country, principle) or small (a building project, the care of a pet). The important thing was that, in ascribing value to the cause and seeing it as worth making sacrifices for, we give our lives meaning.

Assisted living most often became a mere layover on the way from independent living to a nursing home. It became part of the now widespread idea of a “continuum of care,” which sounds perfectly nice and logical but manages to perpetuate conditions that treat the elderly like preschool children. Concern about safety and lawsuits increasingly limited what people could have in their assisted living apartments, mandated what activities they were expected to participate in, and defined ever more stringent move-out conditions that would trigger “discharge” to a nursing facility. The language of medicine, with its priorities of safety and survival, was taking over, again. Wilson pointed out angrily that even children are permitted to take more risks than the elderly. They at least get to have swings and jungle gyms.

Two-thirds of the terminal cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did have discussions were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive care unit. Most of them enrolled in hospice. They suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In addition, six months after these patients died, their family members were markedly less likely to experience persistent major depression. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.

By all means let an observant Jewish adult male have his raw-cut penis placed in the mouth of a rabbi. (That would be legal, at least in New York.) By all means let grown women who distrust their clitoris or their labia have them sawn away by some other wretched adult female. By all means let Abraham offer to commit filicide to prove his devotion to the Lord or his belief in the voices he was hearing in his head. By all means let devout parents deny themselves the succor of medicine when in acute pain and distress. By all means—for all I care—let a priest sworn to celibacy be a promiscuous homosexual. By all means let a congregation that believes in whipping out the devil choose a new grown-up sinner each week and lash him until he or she bleeds. By all means let anyone who believes in creationism instruct his fellows during lunch breaks. But the conscription of the unprotected child for these purposes is something that even the most dedicated secularist can safely describe as a sin.

Until fairly recently, every family had a cornucopia of favorite home remedies--plants and household items that could be prepared to treat minor medical emergencies, or to prevent a common ailment becoming something much more serious. Most households had someone with a little understanding of home cures, and when knowledge fell short, or more serious illness took hold, the family physician or village healer would be called in for a consultation, and a treatment would be agreed upon. In those days we took personal responsibility for our health--we took steps to prevent illness and were more aware of our bodies and of changes in them. And when illness struck, we frequently had the personal means to remedy it. More often than not, the treatment could be found in the garden or the larder. In the middle of the twentieth century we began to change our outlook. The advent of modern medicine, together with its many miracles, also led to a much greater dependency on our physicians and to an increasingly stretched healthcare system. The growth of the pharmaceutical industry has meant that there are indeed "cures" for most symptoms, and we have become accustomed to putting our health in the hands of someone else, and to purchasing products that make us feel good. Somewhere along the line we began to believe that technology was in some way superior to what was natural, and so we willingly gave up control of even minor health problems.

[T]he old stories of human relationships with animals can't be discounted. They are not primitive; they are primal. They reflect insights that came from considerable and elaborate systems of knowledge, intellectual traditions and ways of living that were tried, tested, and found true over many thousands of years and on all continents. But perhaps the truest story is with the animals themselves because we have found our exemplary ways through them, both in the older world and in the present time, both physically and spiritually. According to the traditions of the Seneca animal society, there were medicine animals in ancient times that entered into relationships with people. The animals themselves taught ceremonies that were to be performed in their names, saying they would provide help for humans if this relationship was kept. We have followed them, not only in the way the early European voyagers and prenavigators did, by following the migrations of whales in order to know their location, or by releasing birds from cages on their sailing vessels and following them towards land, but in ways more subtle and even more sustaining. In a discussion of the Wolf Dance of the Northwest, artists Bill Holm and William Reid said that 'It is often done by a woman or a group of women. The dance is supposed to come from the wolves. There are different versions of its origin and different songs, but the words say something like, 'Your name is widely known among the wolves. You are honored by the wolves.' In another recent account, a Northern Cheyenne ceremonialist said that after years spent recovering from removals and genocide, indigenous peoples are learning their lost songs back from the wolves who retained them during the grief-filled times, as thought the wolves, even though threatened in their own numbers, have had compassion for the people.... It seems we have always found our way across unknown lands, physical and spiritual, with the assistance of the animals. Our cultures are shaped around them and we are judged by the ways in which we treat them. For us, the animals are understood to be our equals. They are still our teachers. They are our helpers and healers. They have been our guardians and we have been theirs. We have asked for, and sometimes been given, if we've lived well enough, carefully enough, their extraordinary powers of endurance and vision, which we have added to our own knowledge, powers and gifts when we are not strong enough for the tasks required of us. We have deep obligations to them. Without other animals, we are made less. (from her essay "First People")

In the course of my life I have had pre-pubescent ballerinas; emaciated duchesses, dolorous and forever tired, melomaniac and morphine-sodden; bankers' wives with eyes hollower than those of suburban streetwalkers; music-hall chorus girls who tip creosote into their Roederer when getting drunk... I have even had the awkward androgynes, the unsexed dishes of the day of the *tables d'hote* of Montmartre. Like any vulgar follower of fashion, like any member of the herd, I have made love to bony and improbably slender little girls, frightened and macabre, spiced with carbolic and peppered with chlorotic make-up. Like an imbecile, I have believed in the mouths of prey and sacrificial victims. Like a simpleton, I have believed in the large lewd eyes of a ragged heap of sickly little creatures: alcoholic and cynical shop girls and whores. The profundity of their eyes and the mystery of their mouths... the jewellers of some and the manicurists of others furnish them with *eaux de toilette*, with soaps and rouges. And Fanny the etheromaniac, rising every morning for a measured dose of cola and coca, does not put ether only on her handkerchief. It is all fakery and self-advertisement - *truquage and battage*, as their vile argot has it. Their phosphorescent rottenness, their emaciated fervour, their Lesbian blight, their shop-sign vices set up to arouse their clients, to excite the perversity of young and old men alike in the sickness of perverse tastes! All of it can sparkle and catch fire only at the hour when the gas is lit in the corridors of the music-halls and the crude nickel-plated decor of the bars. Beneath the cerise three-ply collars of the night-prowlers, as beneath the bulging silks of the cyclist, the whole seductive display of passionate pallor, of knowing depravity, of exhausted and sensual anaemia - all the charm of spicy flowers celebrated in the writings of Paul Bourget and Maurice Barres - is nothing but a role carefully learned and rehearsed a hundred times over. It is a chapter of the MANCHON DE FRANCINE read over and over again, swotted up and acted out by ingenious barnstormers, fully conscious of the squalid salacity of the male of the species, and knowledgeable in the means of starting up the broken-down engines of their customers. To think that I also have loved these maleficent and sick little beasts, these fake Primaveras, these discounted Jocondes, the whole hundred-franc stock-in-trade of Leonardos and Botticellis from the workshops of painters and the drinking-dens of aesthetes, these flowers mounted on a brass thread in Montparnasse and Levallois-Perret! And the odious and tiresome travesty - the corsetted torso slapped on top of heron's legs, painful to behold, the ugly features primed by boulevard boxes, the fake Dresden of Nina Grandiere retouched from a medicine bottle, complaining and spectral at the same time - of Mademoiselle Guilbert and her long black gloves!... Have I now had enough of the horror of this nightmare! How have I been able to tolerate it for so long? The fact is that I was then ignorant even of the nature of my sickness. It was latent in me, like a fire smouldering beneath the ashes. I have cherished it since... perhaps since early childhood, for it must always have been in me, although I did not know it!

Kate?” Anthony yelled again. He couldn’t see anyone; a dislodged bench was blocking the opening. “Can you hear me?” Still no response. “Try the other side,” came Edwina’s frantic voice. “The opening isn’t as crushed.” Anthony jumped to his feet and ran around the back of the carriage to the other side. The door had already come off its hinges, leaving a hole just large enough for him to stuff his upper body into. “Kate?” he called out, trying not to notice the sharp sound of panic in his voice. Every breath from his lips seemed overloud, reverberating in the tight space, reminding him that he wasn’t hearing the same sounds from Kate. And then, as he carefully moved a seat cushion that had turned sideways, he saw her. She was terrifyingly still, but her head didn’t appear to be stuck in an unnatural position, and he didn’t see any blood. That had to be a good sign. He didn’t know much of medicine, but he held on to that thought like a miracle. “You can’t die, Kate,” he said as his terrified fingers yanked away at the wreckage, desperate to open the hole until it was wide enough to pull her through. “Do you hear me? You can’t die!” A jagged piece of wood sliced open the back of his hand, but Anthony didn’t notice the blood running over his skin as he pulled on another broken beam. “You had better be breathing,” he warned, his voice shaking and precariously close to a sob. “This wasn’t supposed to be you. It was never supposed to be you. It isn’t your time. Do you understand me?” He tore away another broken piece of wood and reached through the newly widened hole to grasp her hand. His fingers found her pulse, which seemed steady enough to him, but it was still impossible to tell if she was bleeding, or had broken her back, or had hit her head, or had . . . His heart shuddered. There were so many ways to die. If a bee could bring down a man in his prime, surely a carriage accident could steal the life of one small woman. Anthony grabbed the last piece of wood that stood in his way and heaved, but it didn’t budge. “Don’t do this to me,” he muttered. “Not now. It isn’t her time. Do you hear me? It isn’t her time!” He felt something wet on his cheeks and dimly realized that it was tears. “It was supposed to be me,” he said, choking on the words. “It was always supposed to be me.” And then, just as he was preparing to give that last piece of wood another desperate yank, Kate’s fingers tightened like a claw around his wrist. His eyes flew to her face, just in time to see her eyes open wide and clear, with nary a blink. “What the devil,” she asked, sounding quite lucid and utterly awake, “are you talking about?” Relief flooded his chest so quickly it was almost painful. “Are you all right?” he asked, his voice wobbling on every syllable. She grimaced, then said, “I’ll be fine.” Anthony paused for the barest of seconds as he considered her choice of words. “But are you fine right now?” She let out a little cough, and he fancied he could hear her wince with pain. “I did something to my leg,” she admitted. “But I don’t think I’m bleeding.” “Are you faint? Dizzy? Weak?” She shook her head. “Just in pain. What are you doing here?” He smiled through his tears. “I came to find you.” “You did?” she whispered. He nodded. “I came to— That is to say, I realized . . .” He swallowed convulsively. He’d never dreamed that the day would come when he’d say these words to a woman, and they’d grown so big in his heart he could barely squeeze them out. “I love you, Kate,” he said chokingly. “It took me a while to figure it out, but I do, and I had to tell you. Today.” Her lips wobbled into a shaky smile as she motioned to the rest of her body with her chin. “You’ve bloody good timing.

Stop staring at Kevin so much. You're making me fear for your life over here." "What do you mean?" "Andrew is scary territorial of him. He punched me the first time I said I'd like to get Kevin too wasted to be straight." Nicky pointed at his face, presumably where Andrew had decked him. "So yeah, I'm going to crush on safer targets until Andrew gets bored of him. That means you, since Matt's taken and I don't hate myself enough to try Seth. Congrats." "Can you take the creepy down a level?" Aaron asked. "What?" Nikcy asked. "He said he doesn't swing, so obviously he needs a push." "I don't need a push," Neil said. "I'm fine on my own." "Seriously, how are you not bored of your hand by now?" "I'm done with this conversation," Neil said. "This and every future variation of it. [...]" The stadium door slammed open as Andrew showed up at last. He swept them with a wide-eyed look as if surprised to see them all there. "Kevin wants to know what's taking you so long. Did you get lost?" "Nicky's scheming to rape Neil," Aaron said. "There are a couple flaws in his plan he needs to work out first, but he'll get there sooner or later." [...] "Wow, Nicky," Andrew said. "You start early." "Can you really blame me?" Nicky glanced back at Neil as he said it. He only took his eyes off Andrew for a second, but that was long enough for Andrew to lunge at him. Andrew caught Nicky's jersey in one hand and threw him hard up against the wall. [...] "Hey, Nicky," Andrew said in stage-whisper German. "Don't touch him, you understand?" "You know I'd never hurt him. If he says yes-" "I said no." "Jesus, you're greedy," Nicky said. "You already have Kevin. Why does it-" He went silent, but it took Neil a moment to realize why. Andrew had a short knife pressed to Nicky's Jersey. [...] Neil was no stranger to violence. He'd heard every threat in the book, but never from a man who smiled as bright as Andrew did. Apathy, anger, madness, boredom: these motivators Neil knew and understood. But Andrew was grinning like he didn't have a knife point where it'd sleep perfectly between Nicky's ribs, and it wasn't because he was joking. Neil knew Andrew meant it. If Nicky so much as breathed wrong right now, Andrew would cut his lungs to ribbons, any and all consequences be damned. Neil wondered if Andrew's medicine would let him grieve, or if he'd laugh at Nicky's funeral too. Then he wondered if a sober Andrew would act any different. Was this Andrew psychosis or his medicine? Was he flying too high to understand what he was doing, or did his medicine only add a smile to Andrew's ingrained violence? [...] Andrew let go of Nicky and spun away. [...] Aaron squized Nicky's shoulder on his way out. Nicky looked shaken as he stared after the twins, but when he realized Neil was watching him he rallied with a smile Neil didn't believe at all. "On second thought, you're not my type after all,” Nicky said [...]. "Don't let him get away with things like that." Nicky considered him for a moment, his smile fading into something small and tired. "Oh, Neil. You're going to make this so hard on yourself. Look, [...] Andrew is a little crazy. Your lines are not his lines, so you can get all huff and puff when he tramps across yours but you'll never make him understand what he did wrong. Moreover, you'll never make him care. So just stay out of his way." "He's like this because you let him get away with it," Neil said. [...] "That was my fault. [...] I said something I shouldn't have, and got what I deserved.

Be big enough to offer the truth to people and if it short circuits them I think that's tragic. I think that's sad but, I will not strike no unholy bargains to self erase. I wont do it. I don't care how many people fucked up their lives. I don't care how many bad choices people have made. I don't care how much pettiness they've consumed and spat out. I don't care how much viciousness , rage, abuse, spanking they've dealt out. I am gonna tell the truth as I see it and I'm going to be who I fucking am and if that causes the world to shift in it's orbit and half the evil people get thrown off the planet and up into space well, you shouldn't of been standing in evil to begin with because, there is gravity in goodness. So, sorry; I have to be who I am. Everyone ells is taken. There is no other place I can go than in my own head. I can't jump from skull to skull until I find one that suits bad people around me better. I don't have that choice. So, be your fucking self. Speak your truth and if there are people around you who tempt you with nonexistence , blast through that and give them the full glory of who you are. Do not withhold yourself from the world. Do not piss on the incandescent gift of your existence. Don't drown yourself in the petty fog and dustiness of other peoples ancient superstitions, beliefs, aggressions, culture, and crap. No, be a flare. We're all born self expressive. We are all born perfectly comfortable with being incredibly inconvenient to our parents. We shit, piss, wake up at night, throw up on their shoulders, scream, and cry. We are in our essence, in our humanity, perfectly comfortable with inconveniencing others. That's how we are born. That's how we grow. That's how we develop. Well, I choose to retain the ability to inconvenience the irrational. You know I had a cancer in me last year and I'm very glad that the surgeons knife and the related medicines that I took proved extremely inconvenient to my cancer and I bet you my cancer was like "Aw shit. I hate this stuff man." Good. I'm only alive because medicine and surgery was highly inconvenient to the cancer within me. That's the only reason I'm alive. So, be who you are. If that's inconvenient to other people that's their goddamn business, not yours. Do not kill yourself because other people are dead. Do not follow people into the grave. Do not atomize yourself because, others have shredded themselves into dust for the sake of their fears and their desire to conform with the history of the dead.

Countries measured their success by the size of their territory, the increase in their population and the growth of their GDP – not by the happiness of their citizens. Industrialised nations such as Germany, France and Japan established gigantic systems of education, health and welfare, yet these systems were aimed to strengthen the nation rather than ensure individual well-being. Schools were founded to produce skilful and obedient citizens who would serve the nation loyally. At eighteen, youths needed to be not only patriotic but also literate, so that they could read the brigadier’s order of the day and draw up tomorrow’s battle plans. They had to know mathematics in order to calculate the shell’s trajectory or crack the enemy’s secret code. They needed a reasonable command of electrics, mechanics and medicine in order to operate wireless sets, drive tanks and take care of wounded comrades. When they left the army they were expected to serve the nation as clerks, teachers and engineers, building a modern economy and paying lots of taxes. The same went for the health system. At the end of the nineteenth century countries such as France, Germany and Japan began providing free health care for the masses. They financed vaccinations for infants, balanced diets for children and physical education for teenagers. They drained festering swamps, exterminated mosquitoes and built centralised sewage systems. The aim wasn’t to make people happy, but to make the nation stronger. The country needed sturdy soldiers and workers, healthy women who would give birth to more soldiers and workers, and bureaucrats who came to the office punctually at 8 a.m. instead of lying sick at home. Even the welfare system was originally planned in the interest of the nation rather than of needy individuals. When Otto von Bismarck pioneered state pensions and social security in late nineteenth-century Germany, his chief aim was to ensure the loyalty of the citizens rather than to increase their well-being. You fought for your country when you were eighteen, and paid your taxes when you were forty, because you counted on the state to take care of you when you were seventy.30 In 1776 the Founding Fathers of the United States established the right to the pursuit of happiness as one of three unalienable human rights, alongside the right to life and the right to liberty. It’s important to note, however, that the American Declaration of Independence guaranteed the right to the pursuit of happiness, not the right to happiness itself. Crucially, Thomas Jefferson did not make the state responsible for its citizens’ happiness. Rather, he sought only to limit the power of the state.